Narrative inquiry in bioethics最新文献

{"title":"Circumcision and Regrets from the Mother of Three Sons","authors":"María Viola Sánchez","doi":"10.1353/nib.2023.a909675","DOIUrl":"https://doi.org/10.1353/nib.2023.a909675","url":null,"abstract":"Circumcision and Regrets from the Mother of Three Sons María Viola Sánchez I am a psychologist and a radio talk show host for 25+ years. Both of my parents spoke English as their second language. I was raised by immigrants who demanded that \"we speak English because we are Americans.\" I have four adult children, three sons, and a daughter. I gave birth to my children in the mid-80s. They are very close in age and remain dear friends to this day. While I was a professional with a career when my children were born, I took a leave to work part-time and largely, to be a stay-at-home mother for nearly ten years. I was very involved with all their academic and extracurricular activities. I became a single mother when they were 2, 4, 6, and 7 years old, which served to redouble my parenting efforts to compensate for the absence of their father. My dirty secret is that I circumcised my three sons. I did so out of sheer ignorance. I am ashamed and deeply saddened by my decision at the time of their births. This is a burden that I will live with for the rest of my life. Something that I took away from them and that I can never repair. Here's the justification for my ill-informed decision. My father was circumcised, my two brothers were circumcised, and my then-husband was circumcised. I blindly assumed all males were to be circumcised. Further complicating the circumstances surrounding their births and the decision to circumcise them is the fact that their father is Jewish. He most likely would have given me pushback on not circumcising our sons, even though we had agreed to raise our family as Roman Catholics, my religion. After delivering my sons, I was asked, \"Who would you like to circumcise your son?\" My reply was, \"Who has performed more of these procedures? And please bring my son to me to nurse after you have finished.\" Not one person, not one family member, not my son's father, any healthcare providers, not my pediatrician, or my OB/GYN asked me, \"What are your thoughts about circumcising your son?\" Had I been asked that question, I might have pondered the concept that there was a decision to be made, not a procedure that was necessary, as is the case with cutting the umbilical cord. When my infant sons were brought to me to nurse, they were sobbing so violently that they were unable to latch on to my breast. One can only surmise that no numbing agents were applied or anesthesia given, further compounding my burden of responsibility. Imagine their trauma! Over the course of my radio career, I hosted a program for an American non-profit national media organization, and one of my guests, Steven Svoboda, was scheduled to promote his newly founded organization, Attorneys for the Rights of the Child (ARC). Steven has remained a colleague. I've interviewed him a dozen times over the decades to promote ARC's amazing work. Steven is the one that first opened my eyes to the ridiculousness of male circumcision. Subsequently, I now understand that circumcisi","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Do We Owe to Patients Who Leave Against Medical Advice? The Ethics of AMA Discharges","authors":"Leenoy Hendizadeh, Paula Goodman-Crews, Jeannette Martin, Eli Weber","doi":"10.1353/nib.2023.a909674","DOIUrl":"https://doi.org/10.1353/nib.2023.a909674","url":null,"abstract":"Abstract: Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Political Becomes Personal: Circumcision as a Cause and as a Parental Decision","authors":"J. Steven Svoboda","doi":"10.1353/nib.2023.a909659","DOIUrl":"https://doi.org/10.1353/nib.2023.a909659","url":null,"abstract":"When the Political Becomes Personal:Circumcision as a Cause and as a Parental Decision J. Steven Svoboda As I prepared for the arrival of my first child, a son, a central activity that I previously saw as political suddenly also became very personal. I had founded a non-profit organization in 1997 devoted to educating the world that genital cutting of a child, regardless of a child's gender, is unnecessary and harmful. This includes male circumcision. In 2001, as part of my non-profit work I led a team that went to the United Nations in Geneva and for the first time, put the issue of male circumcision as a human rights violation in the United Nations record. At the time, my then wife was pregnant with our first child, a son. (I had the ultrasound photo of my son-to-be on my nightstand while in Geneva.) Now the circumcision question would be posed to me! A few months after the Geneva trip, when it came time in early 2002 for my son's birth on the US territory of Guam, I naturally was never going to agree to the procedure. Nevertheless, I was trying not to inject my own beliefs into the arrival of my first child. My children's mother, while Jewish, is a pediatrician who always had some doubts about the wisdom of circumcision and easily agreed with my desire to keep our son intact. No one in either of our families had any serious problems with our decision. The nurse at the hospital in Guam where my wife worked and gave birth asked me a total of five separate times if I wanted my son to be circumcised. Each time, I answered, \"No,\" without saying more, until the fifth time, when I politely added, \"You do know that there is no medical reason for this to be done, right?\" The nurse replied in a chirpy voice, \"I know.\" I then asked, \"Why do you ask parents about it then?\" She replied, \"Because they want it sometimes.\" Well, the odd thing about that is there is no other medically unnecessary procedure on their children for which parents are repeatedly solicited. And if I had agreed even one time, I am sure that my child would have been circumcised [End Page 73] without any follow-up questions to make sure I really wanted this done. Besides, at least in the absence of any medical condition making it necessary (which is essentially never the case), it should not be my decision to make, nor his mother's, but rather the child's whose body it is. The oddest aspect of this whole chain of events may be that I was not given a single shred of information explaining why I should support my son being cut. My son had zero issues after being left intact, and how could it be otherwise? My advice, naturally, to parents expecting boys (or girls, or intersex children, for that matter) is to educate yourself. You will learn, the more you look into these issues, that there are thousands of people around the world, including countless physicians and other experts, who believe childhood circumcision is as outmoded, useless, and as harmful a practice as footbinding. Why not le","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editors' Note","authors":"James M. DuBois, Ana S. Iltis, Heidi A. Walsh","doi":"10.1353/nib.2023.a909655","DOIUrl":"https://doi.org/10.1353/nib.2023.a909655","url":null,"abstract":"Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh Dionne Deschenne was 30 weeks pregnant with her son when she contracted a serious case of pneumonia, requiring her to have an emergency C-section. Her son spent weeks in the NICU after his premature birth. Deschenne writes, \"Under the conditions, I relied on the hospital staff to help me understand the risks, benefits, and necessities of each procedure or test they recommended. We formed a relationship of mutual respect.\" One day when Deschenne's doctor was making rounds, a nurse asked if she wanted to have her son circumcised while the doctor had time and was available. \"The nurse bringing up circumcision was one with whom I had built a relationship of trust over the previous days. I considered her a trusted advisor. I asked her what the benefits would be? What would the risks be? Would my son experience pain? Was operating on such a tiny and ill baby safe?\" Authors in this issue of \"Narrative Inquiry in Bioethics\" pondered similar questions. In the symposium, \"Newborn Male Circumcision,\" we aimed to explore the decision making process of parents when choosing whether to have their infant male children circumcised. Through the symposium, we hoped to gain insights about what information or resources parents lack or would find helpful as they decide. \"Overall, even though it was a very difficult decision, I think it was the right one for my son and our family,\" says Anonymous Two, one of 14 authors who contributed a story. \"I don't think it's right for others to judge parents that make the choice to circumcise their sons. I don't think it's an easy choice for most of them—it certainly wasn't an easy choice for me.\" Twelve stories are included in the symposium; two additional narratives are published in the online supplement. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium editor, Heidi A. Walsh, makes the observation that \"while shared decision making is not an overarching theme in the stories, the authors demonstrate that circumcision decisions are not straightforward for many parents and discussion with a trusted healthcare provider could have been helpful.\" The four commentary articles by Lauren L. Baker, Laura M. Carpenter, Shawn D. O'Connor and Claudio J. Kogan offer important insights into the authors' stories. Comatose survivors of cardiac arrest often die after life-sustaining therapy is withdrawn. Family members, acting as surrogate decision makers, are frequently asked to decide whether their loved one should continue to receive ongoing mechanical ventilation or o","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Collection of Personal Narratives","authors":"","doi":"10.1353/nib.2023.a909677","DOIUrl":"https://doi.org/10.1353/nib.2023.a909677","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surprised Divide","authors":"Anonymous One","doi":"10.1353/nib.2023.a909657","DOIUrl":"https://doi.org/10.1353/nib.2023.a909657","url":null,"abstract":"Surprised Divide Anonymous One Anonymous One Not long after our daughter was born, my wife and I were expecting a son. We were busy new parents, so her pregnancy with our second child went by quickly and without a lot of the fuss that a first pregnancy brings. To our surprise, our son was born a few weeks early but aside from a little jaundice he was a happy, healthy baby. My parents were caring for our daughter while we were at the hospital. After my son's birth, we were excited for them to bring our daughter up to the hospital to visit her new baby brother. The hospital photographer came by and took photos of our two kids together and photos of our son swaddled and sleeping soundly in a basket. Other family members stopped by to meet the new baby as well. It was a happy time. Little did we know that a couple of hours later we would be faced with a communication breakdown. My wife and I usually pride ourselves on how well we are able to communicate and plan our future. I grew up heavily Catholic, attending parochial schools through high school graduation. Meanwhile, my wife's family are Unitarian Universalists. You could not have two more polar opposite religions! We are used to having different points of view. We have always talked through many of life's choices and have both had to make compromises in order to have a successful relationship. It was on that happy day of my son's birth that we discovered we forgot to discuss one important topic. As our family was gathered in my wife's hospital room, joyfully celebrating the newest addition, the doctor entered the room to check on my wife and said it was time to do the circumcision if we wanted. Without hesitation, I responded in the affirmative, then the doctor and I looked over at my wife, who was staring at us with saddened, conflicted eyes. I was confused. Didn't she want the same thing for our son that I did? Surprisingly we never discussed this decision, at least not that I remember. I don't recall her ever telling me she was against it. My wife stated that she wasn't prepared to make a decision because she didn't know what our son would want and she was worried about him experiencing pain. She worked hard for 9 months to grow this baby boy, and he was so little. I understood her anguish in the thought of letting someone alter his tiny body. I am circumcised myself. My background provided me guidance and an expectation that this would be happening, so it was a nonissue for me. I never considered a scenario in which my son would not be circumcised. In truth, it felt ridiculous to even contemplate not circumcising him. My words of reassurance that it would be fine and my explanation to my wife that this was just one of the many decisions we would need to make for him and our other child did little to settle her. It was clear that no one (including me) had discussed this with my wife prior to this point, which was unfortunate. The doctor described the process and tried to reassure my wife that","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making Choices—Newborn Male Circumcision","authors":"Shawn D. O'Connor","doi":"10.1353/nib.2023.a909671","DOIUrl":"https://doi.org/10.1353/nib.2023.a909671","url":null,"abstract":"Abstract: Newborn male circumcision has potential benefits and advantages as well as disadvantages and risks. Families will at times have medical questions regarding newborn male circumcision that clinicians must be prepared to answer.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Brit Milah for Eliezer Herschel ben Yonatan Aryeh","authors":"Molly Sinderbrand","doi":"10.1353/nib.2023.a909668","DOIUrl":"https://doi.org/10.1353/nib.2023.a909668","url":null,"abstract":"A Brit Milah for Eliezer Herschel ben Yonatan Aryeh Molly Sinderbrand For observant Jews, the choice to circumcise one's son is not a choice. Technically, it is a contractual obligation; the belief is that male circumcision is part of a holy covenant with God. The word for ritual circumcision, brit milah or bris, literally means \"covenant [of circumcision].\" Circumcision is a physical symbol of a relationship with the divine. It is the commandment that encompasses all other commandments. It is, thankfully, only required of men (women, they say, are naturally closer to divinity). Circumcision is when a baby boy enters the Jewish community, eight days after birth, and when he gets his name. He becomes somebody. To choose otherwise— and some may choose otherwise—is to choose not to be part of the contract, and by extension, not be part of the Jewish community. And a community is one of the most valuable things a person can have. I was not always an observant Jew, though I was raised in a Jewish household. I essentially fell into observance over a period of 10 years, starting with studying ancient Hebrew with a language-loving rabbi in high school and eventually leading to weekly attendance at an orthodox shul, which I joined shortly after first tasting the vegan cholent at kiddush. It was much easier to make friends in [End Page 91] the Jewish community than in my competitive and mildly misogynist graduate program, and frankly, I liked them better. I received kindness and support when I needed it, and gave it back equally, especially around having children. Having children is difficult under any circumstance, but it is especially difficult in social settings where it is seen as abnormal, strange, or even selfish. The Jewish community normalized having children and created a respite from the judgment of the secular world. When I was pregnant at work, I got comments like \"It looks like you're having twins!\" and \"Are you sure you don't have pre-eclampsia? You look awfully large\"; at shul, I got pep talks, encouragement, and the traditional \"b'sha'a tova\"—\"may it happen at a good time.\" Eventually, after having two kids in a two-bedroom rowhome, my husband and I moved to a mostly-Jewish suburb just outside the city. It is the kind of place where everyone says \"Gut Shabbes\" (a good Sabbath) to each other on Saturdays, but not one in which all the men wear black hats and study Torah all day (though some do). That is, folks live Jewish lives, but interact with the outside world as well. After a few months, it felt like home. This was the context in which I decided—or rather, did not have to decide—to circumcise my son. It was the natural result of the decision to be part of a community that places value (and even membership) on the ritual of circumcision. I made that decision years earlier and have been continuously reaffirming it since. Every day I wake up is a day I decide to be an observant Jew, and I decide to do so in order to be a member of an observ","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newborn Male Circumcision","authors":"Heidi A. Walsh","doi":"10.1353/nib.2023.a909656","DOIUrl":"https://doi.org/10.1353/nib.2023.a909656","url":null,"abstract":"Abstract: This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining Circumcision for My Premature Newborn","authors":"Dionne Deschenne","doi":"10.1353/nib.2023.a909667","DOIUrl":"https://doi.org/10.1353/nib.2023.a909667","url":null,"abstract":"Declining Circumcision for My Premature Newborn Dionne Deschenne In 1993, I was pregnant with my first of three sons and was busy preparing for his arrival. Unlike most parents, who focus much of their time on decorating the nursery and buying supplies, I was researching the medical decisions that I would need to make in the moments and weeks following his birth. Having worked in a hospital while a pre-medicine student, I had heard the cries of babies undergoing tests and procedures shortly after birth and knew I needed to be clear on the necessity of those tests and procedures if I was going to consent to them for my baby. My husband was in the Navy and out to sea for six months, so I took a few college courses to pass the time. One was a philosophy course on ethics, and I chose the bioethics of infant male circumcision as the focal point of my coursework that quarter. This allowed me to work through my findings in a racially, religiously, and age-diverse classroom under the guidance of a skilled professor. I was shocked to learn that even the American Academy of Pediatrics (AAP) at that time acknowledged that there were no known medical benefits that resulted from circumcision. How, I wondered, could parents allow their newborns to undergo such a harrowing experience for no reason? As the months passed and the birth of our first son grew nearer, I had everything ready—all of the decisions made, the doctors prepared, and the hospital selected. All of that preparation went out the proverbial window when I contracted pneumonia at 30 weeks. I was admitted to the Naval Hospital and treated for a week before being airlifted to a nearby Army Hospital when my condition worsened. After a few days there, the doctor came in very early one morning to wake me. Our son's heart rate was slowing, and we were at risk of losing him. They needed to immediately perform an emergency Cesarean section to preserve his life. I was terrified, knowing the potential myriad adverse effects his pre-term birth could cause. We were rushed into the OR and within seconds I had an epidural in my back. Moments later, my perfect, tiny but silent baby was whisked from the room to be attended to by a highly skilled and immensely respected NICU team. My husband followed to keep a watchful eye on our son while I was taken to Recovery. A few hours later, I was allowed to join my husband and son in the NICU. Our baby was beautiful, but so tiny that my husband could hold him in one hand. He weighed four pounds and had an enormous needle in the top of his head. The nurse explained to me that the IV needle was in the best location for administering the IV fluids and medications that our baby needed. His pre-term birth had introduced the need for several tests and treatments I had not anticipated. This was immensely distressing for me as someone who wanted to research and understand so that I could make well-informed and ethical decisions. Keep in mind that this was in the days before smart","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}